title: Changes in cysteinyl leukotrienes during and after cardiac surgery with cardiopulmonary bypass in patients with and without chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  Pulmonary function frequently deteriorates after cardiopulmonary bypass (CPB). Chronic obstructive pulmonary disease (COPD) increases risk of respiratory complications after CPB. Cysteinyl leukotrienes are important mediators of respiratory dysfunction. Their role during cardiac surgery and its lung complications is incompletely understood. We studied whether production of cysteinyl leukotrienes changes during and after cardiac surgery with CPB and differs between patients with and without COPD.
  
  
  METHODS
  Patients with (n = 9) and without (n = 10) moderate-to-severe COPD undergoing cardiac surgery with CPB were prospectively included. Plasma and urinary cysteinyl leukotriene and leukotriene B(4) concentrations were measured by enzyme-linked immunosorbent assay after anesthesia induction, at end of CPB, after CPB, and 2 hours after intensive care unit admission. Gas exchange and respiratory mechanics were also assessed.
  
  
  RESULTS
  Patients with COPD had larger airway resistances after CPB and chest closure (P < .001), lower ratio of arterial Po(2) to inspired oxygen fraction at intensive care unit admission (215 ± 37 vs 328 ± 30 mm Hg, P < .05), and longer postoperative mechanical ventilation (13.7 ± 5.8 vs 6.8 ± 3.4 hours, P < .01). Urinary cysteinyl leukotriene concentrations increased with time in both groups (P < .01), but more in patients with than without COPD (P < .05). Plasma cysteinyl leukotriene concentrations increased significantly between baseline and intensive care unit admission in patients with but not without COPD (P < .01). Concentrations of leukotriene B(4) in plasma and urine did not increase significantly with time and were not different between groups.
  
  
  CONCLUSIONS
  Release of cysteinyl leukotrienes increases during cardiac surgery with CPB and is larger in patients with than without COPD. This may be related to higher lung and airway production of cysteinyl leukotrienes and neutrophil activation in patients with COPD.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Nicolas
authors.initials: N
authors.lastname: de Prost
authors.forename: Claudine
authors.initials: C
authors.lastname: El-Karak
authors.forename: Maria
authors.initials: M
authors.lastname: Avila
authors.forename: Fumito
authors.initials: F
authors.lastname: Ichinose
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Vidal Melo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001900:Boston; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D016009:Chi-Square Distribution; D003545:Cysteine / Q000097:blood / Q000652:urine; D004797:Enzyme-Linked Immunosorbent Assay; D006331:Heart Diseases / Q000276:immunology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood / Q000652:urine; D007975:Leukotriene B4 / Q000097:blood / Q000652:urine; D015289:Leukotrienes / Q000097:blood / Q000652:urine; D008168:Lung / Q000503:physiopathology; D008875:Middle Aged; D018375:Neutrophil Activation; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000276:immunology* / Q000503:physiopathology; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial; D015656:Respiratory Mechanics; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D015289:Leukotrienes; C112381:cysteinyl-leukotriene; D007975:Leukotriene B4; D003545:Cysteine